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Case Reports
. 2022 Jun;36(6):1709-1714.
doi: 10.1053/j.jvca.2021.03.004. Epub 2021 Mar 6.

Bivalirudin as a Systemic Anticoagulant and Flush Solution Additive for Sequential Mitral and Tricuspid Valve Percutaneous Edge-to-Edge Repair in a Patient With Heparin-Induced Thrombocytopenia

Zachary Colbaugh  1 , Thomas Evans Watts 3rd  2 , Mustafa I Ahmed  2 , Dylan R Addis  3
Affiliations
Case Reports

Bivalirudin as a Systemic Anticoagulant and Flush Solution Additive for Sequential Mitral and Tricuspid Valve Percutaneous Edge-to-Edge Repair in a Patient With Heparin-Induced Thrombocytopenia

Zachary Colbaugh et al. J Cardiothorac Vasc Anesth. 2022 Jun.

Abstract

Herein the case of a patient with a prior history of heparin-induced thrombocytopenia who underwent percutaneous mitral valve edge-to-edge repair that was followed by a tricuspid edge-to-edge repair two months later is presented. Recommendations exist for systemic anticoagulant alternatives for percutaneous mitral valve edge-to-edge repair with the MitraClip device (Abbott, Chicago, IL), but minimal guidance and experience are present regarding alternative systemic anticoagulation during the performance of right-sided interventions, including tricuspid edge-to-edge repair (TriClip; Abbott). Notably, there is no clear consensus regarding the use of an alternative anticoagulant in the catheter flush solution for the delivery systems used during these procedures, particularly for right-sided interventions.

Keywords: MitraClip; TriClip; anticoagulation; bivalirudin; heparin-induced thrombocytopenia; percutaneous valve repair.

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Conflict of interest statement

Conflict of Interest The authors declare no competing interests or financial disclosures pertinent to the content of this manuscript. Dr. Ahmed serves as a consultant and proctor for Abbott, Chicago, IL; Edwards Lifesciences, Irvine, CA; and Medtronic, Dublin, Ireland.

Figures

Figure 1.
Figure 1.
Transesophageal echocardiography oriented in a “grasping view” (mid-esophageal aortic valve long axis) with the MitraClip device and delivery system appreciated. This image demonstrates the material within the heart during positioning and deployment at risk of serving as a nidus for thrombus formation.
Figure 2.
Figure 2.
Transesophageal echocardiography biplane view demonstrating the TriClip device within the right heart. This image reiterates the objects within the heart at risk of generating thrombus. RA: right atrium, RV: right ventricle, AV: aortic valve.
Figure 3.
Figure 3.
Proposed approach to the patient with heparin-induced thrombocytopenia presenting for a percutaneous structural heart procedure necessitating systemic anticoagulation. PLEX: plasmapheresis, IVIg: intravenous immunoglobulin, HIT: heparin-induced thrombocytopenia, Ab: antibody.
See this image and copyright information in PMC

References

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